Authors: Kaur R*, Narula S, Parmar V, Kumar A, Basu S, Kavita R, Sharma R and Kaur D.

Institution: GMCH, Sector 32 B, Chandigarh.

Background: Kangaroo mother has been proven to be safe and effective adjuvant in the care of pre term/ low birth weight babies.

Objective: To study the feasibility and attitude of nurses towards Kangaroo Mother Care (KMC) in low birth weight neonates in an Intensive Care Unit.

Methods: KMC is a routine practice in our unit since August 2002. Doctors, nurses and paramedics have been educated and trained in KMC and its benefits. All neonates once stable are provided KMC for a minimum period of 4 hours/24 hours, which was continued till discharge. Mother, father, grand parents and siblings are encouraged to provide KMC and it encouraged in groups to promote psychological support system. Due to non-availability of lycra bands, innovations like sports bra, dupatta (veil) were used to secure the baby in position. Naked baby with booties, nappy and cap on, is secured to the bare bosom of the person providing KMC, but, if objected, it was allowed over the clothes.

Results: Sixty two low birth weight babies were given KMC. Of these19 (31%) were <1000 gm, 32(52%) 1001-1500gms and rest between 1501 and 2500 gms. (smallest 548 grams). KMC was initiated within first week in 50 % and by 2nd week in 27.4%. Mean duration of KMC was 7 days (range 1-48). No significant variation in heart rate, respiratory rate was noticed. Temperature remained within 36.5°C to 37.4°C even in VLBW babies under incubator care. None developed hypothermia or hyperthermia. Oxygen saturation showed improvement by 2-3% in all. Attitude: Nurses felt that the requirement of manpower, close supervision by them and use of heat convectors in NICU decreased considerably. Babies who received KMC had fewer complications and their survival outcome was better. An increase in expressed breast milk in mothers was reported. Mothers accepted KMC well, were more confident in handling their LBW babies. Their milk yield increased and they felt that they are contributing positively in the care of their tiny babies.

Conclusion: KMC is a good, safe and economical alternative to provide preterm care in developing countries having constraints on manpower and equipment. It is well accepted by mothers, families and nurses.

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Authors: Kanya Mukhopadhyay, Prof. Anil Narang, Praveen Kumar, Pradeep GCM*, Uma Arora, Rama Mahajan, Sourabh Dutta

Institute: Division of Neonatology, Deptt. of Paediatrics, Post-Graduate Institute of Medical Education and Research, Chandigarh.

Background: Kangaroo mother care (KMC) was first suggested in 1978 by Edgar Rey in Bogotá, Colombia. It is very important that the father also becomes involved in the care of the infant. This helps build a bond between the father and infant, and also helps the father support the mother in caring for her infant. Objective: To look at the involvement of father in KMC, duration of KMC by father and temperature maintenance of baby during KMC by father.

Methods: This was an observational study conducted between February -and July 2004. The study population consisted of all live born infants who weighed 2000 g and were eligible for KMC. Parents were counselled regarding the technique, benefits of KMC and fathers were asked to provide KMC during daytime. Record was maintained regarding the duration of KMC and family member doing it. Temperature of baby and fathers was recorded before and after the KMC. Social worker involved in the project interviewed the parents informally to know about their perception and response to KMC.

Results: There were total 81 babies eligible for KMC during the month of Feb -July 2004 with mean birth weight of 1364.2+270 gms and mean gestation of 30.5+2.2 weeks. Mean weight at the enrollment was 1363.4+192 gms. KMC was provided by father in 24 (29.6%)cases. Father along with other family members (sister, grandmother, mother-in-law) provided KMC in 28 (34.5%). Mean duration of KMC given by father was 2.8-hours/ day. Mean temperature of father during KMC was 36.8+0.27°C. Mean temperature of baby during KMC was 36.9 + 0.26°C. No baby suffered hypothermia or hyperthermia during KMC. Interview of families where both parents were involved revealed that fathers were more supportive to mother during the hospital stay and after discharge and these babies had increased duration of KMC on follow up.

Conclusion: Fathers and other family members can successfully provide KMC to babies in our country and that their involvement is important for success of KMC during the hospital stay and at home.

Key words: Premature infants, Kangaroo Mother Care, father.

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Institution: Division of Neonatology, Departments of Pediatrics & Obstetrics and Gynaecology, K.G.Medical University, Lucknow.

Background: Kangaroo mother care (KMC), a method employed in certain countries, is a new concept in our country, and hence is being evaluated.

Objective: 1. To study, through a prospective randomized controlled trial, the effect of KMC among low birth weight infants on: (a) Growth, (b) Health outcomes, (c) Breastfeeding, (d) Length of hospital stay, (e) Motor-mental development.

Methods: The study was conducted at two places. (a)Neonatal Intensive Care Unit (NICU) of Children Hospital, of G. M. & Associated Hospitals, Lucknow. (b) Neonatal unit of Queen Mary's Hospital, Lucknow. Seventy-eight infants with birth weight < 2000 gm, who had overcome major adaptation problems to extrauterine life were randomized to KMC(n=41), and to conventional care(n=37). The KMC group infants underwent intrahospital Kangaroo adaptation and received continuous Kangaroo mother care every day, during hospital stay, and at home. The control group received the conventional (warmer/incubator) care as per the policy of the hospital. Both groups were followed periodically up to 6 months of postconceptional age(PCA).

Results: Both the groups were similar regarding all baseline variables at eligibility. Growth: Physical growth indices in terms of weight, body length, and head circumference were found to be similar in the two groups during follow up. However, Kangaroo group infants showed significantly higher mean daily weight gain from the time of enrollment till 40 weeks PCA. Health outcomes during hospitalization: Significantly higher episodes hypothermia, hyperthermia, and apnea were seen in the control group. Health outcome during follow up: KMC group infants had significantly higher episodes of upper respiratory tract infections at 3 months P.C.A. Episodes of serious infections were found to be significantly more in control group, both at 40 weeks and at 3 months PCA. Breastfeeding: Exclusive breastfeeding was found to be significantly more in the KMC group at discharge and at follow up. Length of hospital stay: The KMC group infants had a shorter period of hospital stay than the control infants. Motor-mental development: No difference was seen in the developmental outcome in two groups during follow up.

Conclusions: Kangaroo Mother Care is as safe and effective as the conventional neonatal care. Additional advantages being of, higher incidence of breast-feeding, and lower incidence of serious infections.

Keywords: Kangaroo mother care, breastfeeding, low birth weight.

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Authors: Parikh TB*, Udani RH, Nanavati RN, Rao S.

Background: Kangaroo Mother Care(KMC) is a comprehensive and low cost method for caring for low birth weight babies. The practice of Kangaroo Mother Care needs to be established all over the country.

Objective: 1) To assess the knowledge and practices about KMC amongst health care personnel caring for newborn babies.2) To conduct one day skill based awareness training on KMC for them and assess the improvement in knowledge.

Methods: Setting: Training Center for KMC at a university teaching municipal hospital at Mumbai. The participants were invited from Mumbai and different parts of Maharashtra. A pre designed pretested questionnaire was given to the participants before the start of the training course. One day training on KMC was provided to the participants by various teaching methods. A post test proforma was filled from the participants at the conclusion of the training course. The knowledge was assessed under following headings; 1. Components of KMC, 2. Benefits of KMC, 3. KMC adaptation, 4. Thermoregulation in Newborn 5.Growth in preterm baby, 6. Preterm milk, 7.Monitoring of baby, 8.Discharge criteria and 9.Follow up of KMC babies. Three workshops were conducted.

Results: Total 95 participants attended the workshop (pediatric and obstetric nurses-65, pediatrician and obstetricians-30). None of the participants were following KMC at their institutions. Only minority of the participants knew about the KMC and related domains. After the intervention of one day skill based awareness programme, the participants knowledge improved significantly in all the above aspects (p<0.001). 72% knew components, 80% knew benefits, 75% knew about KMC adaptation. 68% knew definition and problems associated with hypothermia. 65% participants knew about the normal growth in newborns. 34% were well versed with knowledge on preterm milk. 62% were aware of monitoring practices. 45% participants knew criteria for discharge of preterm baby and 55% were aware of follow-up schedule for preterm babies. 97% participants rated the clarity of the content as good.89% expressed that the workshop content was adequate and 11% expressed that it is average.96% expressed that the method of conducting the workshop was good. 80% participants felt that the opportunities for trainee participation were good and 20% expressed it as average.

Conclusions: Present knowledge of the health care personnel about preterm, LBW babies and KMC is unsatisfactory. Interventions like one day skill based awareness programme will be beneficial for the KMC adaptation in our country. More training programmes with onsite skill based training should be carried out.

Acknowledgements: One day skill based awareness programmes on KMC was supported by Save the Children Federation, Inc, USA, Saving Newborn Lives Initiative.

Keywords: Kangaroo mother care, workshop, skill based awareness programme.

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Authors and Institutions: AIIMS, New Delhi; IOG, Chennai; KEM, Mumbai; KGMU, Lucknow; PGI, Chandigarh.

Background: Kangaroo Mother Care (KMC) is a special modality of care of Low Birth Weight (LBW) babies. It fosters their health and well being by promoting effective thermal control, breast feeding, infection prevention and bonding. In most hospitals, modern gadgets like incubators and warmers used to keep LBW baby warm are either not available or too costly. This low cost method for care of LBW babies is an effective alternative for providing warmth in developing countries. So as to disseminate knowledge and practice of KMC, a network of five institutions in India has been formed.

Objective: The main Objectives of the network are

To disseminate awareness regarding KMC among health care providers by conducting workshops in the country and by providing knowledge and evidence for KMC through website.

To catalyze initiation of KMC practice at selected hospitals by onsite training of health personnel in the outreach hospitals.

To provide in service training opportunities for learning KMC to healthcare providers.

To promote research and generate evidence about feasibility of KMC in the community.

Methods: Consensus clinical practice guidelines, teaching-training learning resource materials, in-service training to interested teams(Doctors & Nurses) and support for implementation of KMC in other institutions will be made by networking institutions.

Conclusion: This initiative will lead to widespread awareness and implementation of KMC as alternate method of care for LBW babies in the country. The LRM will be shared with the delegates.